key: cord-274470-82nhmusm
authors: Ricciardi, Gabriella; Biondi, Raoul; Tamagnini, Gabriele
title: Go back to the basics: Cardiac surgery residents at the time of COVID‐19
date: 2020-06-05
journal: J Card Surg
DOI: 10.1111/jocs.14680
sha: 
doc_id: 274470
cord_uid: 82nhmusm

nan

Indeed, if we put the focus on surgery Residents' training, things get further complicated. The best way to improve surgical skills is, of course, practicing in the operating room. Nonetheless, presently trainee's schedule has been disrupted in most of the University Hospitals.

In fact, the number of intensive care unit (ICU) beds and ventilation sites has been limited due to their commitment to the COVID-patients' handling. Therefore, the surgical activity has been redirected towards emergent, urgent, and not delayable cases. Eventually, due to the inhospital risk of disease transmission, the number of working doctors has been restricted and some providers have been moved to hospital areas in dire need of physicians experienced in caring for critically ill patients. The post-COVID-19 training schedules, as expected, have been switched towards a different model.

Giving this challenging setting, Surgery Residents assisted in a mandatory shift from regular practice in the operation theatre to "home-sitting" and remote meetings and discussions. 3 For sure, their field of interests had to expand to epidemiological, immunological, and pneumological concepts. Whether it is true that the pandemic and the correlated diseases still escape complete comprehension of the mechanisms of spreading and tissue-damaging, then every Surgery Resident, who wants to keep up with this new reality, has to dive deep down into the recent broad literature production Hence, how could we, on this as Residents, take the pandemic "special" scenario with a grain of salt?

It turns out the daily routine should be assessed out of the operation room, trying to get the best from this experience and seizing the opportunity to invest energies and the "extra" leisure on those activities we don't usually have time enough for.

On the basis that we are still "rookie" surgeons, regardless of our individual advance in a career, a thorough knowledge of the pathophysiology and the surgical procedures and techniques related to the commonest disorders is crucial. Thus, this seems to be the right circumstance to go back to our desk and study, simply opening the "old but not quite gone" heavy and dusty books, and also to work up our personal skills. Actually, out of this historical crisis could come a moment of enthusiasm, dedication, creativity, innovations, and ideas.

So, we should take out "pen and paper", or laptops, for the high-tech addicted, and get our thinking caps on: time has come to go deeply in scientific literature, write on a new subject or draw/sketch about anatomy or surgery, to mention just a few, taking benefit likewise from the powerful internet-based libraries.

The SOcial MEdia platforms (SoMe), such as LinkedIn or Twitter, provide an excellent example of the unique opportunity of coupling personal professional advancement with up-to-date technological breakthroughs. HCPs achieve from the SoMe tools to share information, to discuss about healthcare policy and practice issues, to promote health behaviors, to engage with the public, and to educate and interact with patients, caregivers, students, and colleagues. 4 and provide health information to the community. 5 The role of these networks is undisguised also from the pandemic perspective since they have been used by world-famous iconic surgeons and doctors to popularize educational daily tips in form of "tweets" or short messages about the disease itself, the way it spreads, the measurements to minimize its diffusion and other related virus-issues.

Beyond chasing a deeper knowledge into our specialty, some of us also chose (or have been forced, given the circumstances) to be personally involved in treating COVID-19 patients. Though at the beginning this appeared just as a different and more selfless way to use our will and time, straightaway it turned out it was a brave leap from our usual training setting. We are facing a crude reality, in which a still elusive disease sustains a lethality rate of 24.6% in the 70 to 79-yearage group and 30% in the 80 to 89 one (data from Istituto Superiore di Sanità, Italy). Those bare numbers do not account for the frustration of treating a patient without a validated therapy.

Aside not being academically prepared to face the SARS-CoV-2 pandemic, we perhaps stumbled on our psychological stability: the "usual" setting does not prepare us for such a highly lethal disease, against which we are almost helpless. However, after few days of blue mood, the instinct to survive prevails and teaches us the real meaning of resilience: "get up and try, try" should not be just a chorus, but an everlasting lesson for our career. Beyond professional and logistical thoughts, despite the self-centered universe in which we usually work and live, we found out and realize how deeply human we are today.

The sudden solitary confinement we were dragged into ended up to be an optimal starting point to mug the compulsory burnout of our reality. Long duty hours, multiple consecutive shifts, and the price of Now that we are entering the so-called "phase two" the given setting is changing again. First of all, the number of COVID-19 patients is slowly decreasing, as well as the number of dedicated ICU beds. On the other hand, the virus will remain endemic in the society, with an estimated R value below 1. As expected, there will be a chance to resume the elective surgical procedures, but especially in this moment, we need a keen eye on deciding which pathologies have to be treated with priority. For example, coronary artery disease showed a higher mortality rate in patients affected by COVID-19, but it's, however, reasonable to think that all the cardiac pathologies affecting the lung circulation-such as symptomatic severe mitral diseases or aortic stenosis-might deserve a priority access to treatment, to increase the survival rate in case of an acquired-Coronavirus infection later on.

To the point, The COVID-19 era is teaching us, as doctors and Residents, that we are scientists before anything else. As such, medicine is not meant to be experienced passively, but it should be learned with an ever-increasing passion to understand deeply the diseases' mechanisms and the rationale supporting therapies and decisions. As surgeons, even more.

It's plain that we feel the hunger to get a knife in our hands all the time. Anyway, suturing and sewing is not the only way we can improve as physicians and-especially so-our human side. Simply cutting and closing wounds, in a moment in which we are being called upon to show maturity and wisdom, could sound more like a whim.

One of the lessons you learn during your surgery fellowship is that our specialty is really multilayered and complex. Awareness of the real meaning behind the mere surgical act of stitching reaches out to gain an insight into our resilient role in this emergency. Getting through the "childish" need and desire to improve our handy skills, we found ourselves far from the leading actors of this pandemic, alone with our desires and ambitions. In that setting the appropriate adult reaction is to develop our future Character, that is the best surgeon we could be.

Covid-19: UK lockdown is 'crucial' to saving lives, say doctors and scientists

The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China

Cardiothoracic education in the time of COVID-19: how I teach It

A social media primer for professionals: digital dos and don'ts

Dangers and opportunities for social media in medicine

The authors declare that there are no conflict of interests.F I G U R E 1 A authors' brain-storming session on a conference call 

http://orcid.org/0000-0003-0592-6585